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Lep compensation form washington state 2026
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- Click ‘Get Form’ to open the lep compensation form in the editor.
- Begin by completing the Worker’s Section. Fill in your work position, claim number, and dates of injury and request. Indicate your working hours and gross earnings for the specified period.
- Answer questions regarding your employer's contributions to medical benefits and whether you are still receiving these benefits. Ensure you sign and date this section.
- Next, move to the Employer’s Section. If your employer is filling it out, they should provide wage details for the specified period, including any vacation, sick leave, or holiday wages paid.
- Finally, have your attending physician complete their section regarding your diagnosis and ability to return to work. They will need to indicate any restrictions and anticipated recovery timelines.
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